Frail and sick seniors who need the medical supports found in long-term care are stuck in retirement homes, says an Ontario coroner’s investigation.

Dr. Dan Cass told the Star his probe of four deaths at Toronto’s In Touch Retirement Living uncovered problems that affect seniors across Ontario.

Seniors entered the Toronto home relatively healthy and then “deteriorated medically or cognitively to a degree where they really needed more care than could be provided in the home,” Cass said. Once that happened there was no process to identify their needs, provide options for help or a place where families could complain.

Cass began his investigation after the Star published a series on retirement home neglect last fall. Roughly 40,000 Ontario seniors live in some 700 retirement homes, which are privately operated and generally have less supports than long-term care nursing homes.

The problem, the Star has found, is the lack of nursing home beds. If retirement home residents with high medical needs cannot find a spot in one of the province’s 77,000 nursing home beds, they will have to pay for extra care. As of last year there 24,000 people on a waiting list for a nursing home bed.

The coroner said there is no need to call an inquest to examine the systemic issues because the Ontario government’s new Retirement Homes Act has created a regulatory authority to impose rules that will fix the problems

“At this point we don’t feel there is need or benefit to consider a coroner’s inquest,” Cass said.

The new act will require the privately-owned retirement homes to re-assess residents’ medical needs. Owners will also be required to tell residents of different care options, like nursing homes, when their health declines.

As well, Cass said, the new Retirement Homes Regulatory Authority will investigate complaints about care.

“At this point I think we’ve established a good initial relationship with Retirement Homes Authority.

“ We’ve got a good rapport. We will be in touch with each other and will watch the issue closely and if there are issues that continue to arise … we will certainly look at it again,” the coroner said.

But seniors’ advocates warn that the complaints system is currently toothless because the government still hasn’t passed the regulations that allow it to remove licenses from problem homes.

Mary Beth Valentine, the registrar of the authority, said in an interview the advocates “are correct — much of the act is not yet in force. We have a limited role at the moment.”

Valentine said she does not know when the act will be fully proclaimed.

“When it is in full force it has the potential to deal with many of the issues.”

The authority has investigated about 30 complaints about neglect but cannot take away licenses until that part of the act is in force she said. Still, police and public health departments are being called in many cases.

At In Touch, the coroner did not investigate the deaths until months after the residents died. Cass said “there was no evidence we could identify that would support claims or concerns about maltreatment, abuse or negligence.”

The Star found many residents of In Touch were so sick they should have been in a nursing home receiving regulated medical care.

An undercover reporter spent a week in the home posing as a resident and found substandard food, a resident left lying on the floor, puddles of urine in the hallway and no toilet paper in washrooms, forcing some residents to use a dirty hand towel instead.

Another story detailed concerns from family and friends that two residents — 74-year-old Danny Henderson and 80-year-old Edith Farrell — died after suffering severe weight loss.

After it was published the family of 83-year-old Nellie Dineno came forward with allegations their mother had medical problems that went untreated.

Last December, Cass launched an investigation into the three deaths. At the time, he said it would be “complicated a little bit” by the fact that he would not be able to autopsy their bodies.

When another resident, Clement Vachon, choked to death on his food in late December, Cass added his death to the investigation.

In Touch owner Elaine Lindo told the Star she would not comment on the coroner’s report.

“What do you want me to say? Nothing happened. It was all a set up,” Lindo said. “You can speak to my lawyer.”

Released yesterday, the coroner’s report found the first three deaths due to “natural disease processes,” caused by the following:

Henderson died of complications from C-difficile, due to antibiotics for pneumonia. C-difficile is a highly infectious bacteria that kills many elderly residents of nursing homes, retirement homes or hospitals.

Farrell suffered from advanced dementia which hampered her ability to eat.

Dineno suffered from acute diarrhea and likely from ischemic colitis, which involves inflammation of the bowels.

And Vachon’s choking death was deemed accidental.

Judith Wahl, executive director of the Advocacy Centre for the Elderly, said the coroner’s investigation shows the office will shine a light on retirement home deaths in the future.

But, Wahl said, relying on new legislation will not help the most vulnerable.

Retirement homes, she said, are private rental accommodations that will charge medically fragile residents for each medical service they need.

The authority, she said, still does not have the powers needed to fully investigate homes.

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